Of the 70 patients, 34 underwent transapical TAVI and 36 underwent surgical AVR. The primary endpoint of all-cause mortality, stroke, and renal failure requiring dialysis was elevated in TAVI vs. AVR: 14.7% vs. 2.8%,
P=0.07. Death rate for TAVI was higher (8.8% vs. 0%) as was stroke (5.9% vs. 2.8%). The incidence of moderate/severe aortic insufficiency was 13% vs. 0%. The authors of this small trial concluded that in these lower-risk elderly patients, transapical TAVI may be inferior to surgical AVR. These surgical results resemble those obtained in our own series of elderly (>80 years) surgical AVR patients. Conclusion While Inhibitors,research,lifescience,medical TAVI seems like a low-risk and simple catheter-based therapy compared with surgical AVR, it is still in its Inhibitors,research,lifescience,medical developmental
phase and should be considered a major intervention with the risks of serious early and late complications. It is of proven value in the care of patients considered to be inoperable because of extensive irreversible comorbidities or frailty.16 We feel that in experienced centers, Inhibitors,research,lifescience,medical conventional surgery is feasible in most patients despite advanced age. In our own data, age alone has not been a predictor of mortality, but rather mortality is associated with easily identifiable extensive comorbidities and frailty. It is generally agreed that patients should be seen for a surgical evaluation before a final decision is made to employ TAVI. This recommendation is in agreement with that of the Inhibitors,research,lifescience,medical FDA, which has approved TAVI only for treatment of inoperable patients. Both conventional AVR and TAVI will continue to improve. Results of ongoing and future studies will influence patient selection for each of these valuable therapies. Selleck Alvespimycin Conflict of Interest Disclosure:
All author has Inhibitors,research,lifescience,medical completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported. Funding/Support: The author has no funding disclosures.
Introduction Degenerative aortic stenosis is the most common acquired valvular heart disease in the developed countries, affecting more than 300,000 people in the United States alone.1 Symptoms of aortic stenosis are latent until there is critical narrowing of the aortic valve that results in left ventricular hypertrophy, increased left ventricular diastolic pressure and left ventricle mass, and increased myocardial oxygen demand causing subendocardial ischemia.2 Once symptoms develop, the prognosis old changes dramatically unless the aortic stenosis is corrected.2 Surgical aortic valve replacement (sAVR) is the recommended therapy for patients with symptomatic aortic stenosis. The most recent American College of Cardiology and American Heart Association (ACC/AHA) guidelines for sAVR are found in Table 1.3 It is important to note that none of these recommendations are based on evidence from large-scale, randomized clinical trials but instead rely on the expert opinion of experienced clinicians.